Healthcare Provider Details

I. General information

NPI: 1801823844
Provider Name (Legal Business Name): JOHN MARK FOLKS D.D.S.,P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY DENTAL ASSOCIATES 1816 NORTH MAIN
MIAMI OK
74354
US

IV. Provider business mailing address

1816 N MAIN ST
MIAMI OK
74354-2748
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-3337
  • Fax:
Mailing address:
  • Phone: 918-542-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5545
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: